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157: SCAPULA WINGING

Eric Shamus, PhD, DPT, PT, CSCS; Mae L. Yahara, MS, PT, ATC

CONDITION/DISORDER SYNONYMS

  • Facioscapulohumeral muscular dystrophy (FSH)

  • Scapula alata

  • Serratus anterior palsy

  • Winging scapula

ICD-9-CM CODE1

  • 736.89 Other acquired deformity of other parts of limb

ICD-10-CM CODE2

  • M21.80 Other specified acquired deformities of unspecified limb

PREFERRED PRACTICE PATTERN3

  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation

PATIENT PRESENTATION

Patient is a 35-year-old male immigrant farm worker who does not speak English. He had an accident at work in which he sustained fractures to the left tibia and fibula which required ORIF. Postoperatively he used a walker with a non-weight bearing gait pattern. As his weight bearing was progressed, he began to utilize one axillary crutch on the right side. He did not receive any instruction with the crutch. He began to notice symptoms in his right shoulder approximately one month later. He states that his girlfriend noticed his shoulder blade “sticking out” and he reported it to the doctor. He is complaining of weakness in the right upper extremity with overhead activities and pain in the right peri-scapular region.

KEY FEATURES

Description

  • Inferior angle tilting of the scapula

  • Instability of the scapula to the thoracic wall

  • Scapula has the greatest number of muscles attached to it than any other bone

  • Scapula dysrhythmia

  • Result of serratus anterior muscle dysfunction

  • Injury to long thoracic nerve

Essentials of Diagnosis

  • Often asymptomatic

  • Winging can help identify a dysfunction possibly occurring in the shoulder

  • Symptoms of pain and weakness

  • Can be a result of a brachial plexus injury

  • Parsonage–Turner syndrome (brachial neuritis) underlying

FIGURE 157-1

Rhomboids (C4, 5; dorsal scapular nerve). The shoulder is thrust backward against resistance. (From Waxman SG: Clinical Neuroanatomy. 26th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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General Considerations

  • Loss of serratus anterior muscle

  • Weakness of trapezius strength

  • Weakness of scapular stabilizers

  • Commonly associated with presence of other orthopedic pathologies: subacromial impingement syndrome, rotator cuff pathology, labral pathology

  • Creates an abnormal scapulothoracic rhythm

  • Commonly associated with repeated overhead or overuse activities

  • Full history of symptoms, medical history screening, and differential shoulder orthopedic examination will ensure appropriate diagnosis

Demographics

  • Non-specific

CLINICAL FINDINGS

SIGNS AND SYMPTOMS

  • Pain

  • Weakness is commonly noted with functional reaching tasks

  • Scapula instability, moving away from rib cage

FIGURE 157-2

(A) Brachial plexus and topography of the axillary artery. (B) Posterior division of the brachial plexus. (C) Posterior view of the shoulder ...

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